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Networked forms of organizing in health care are increasingly viewed as an effective means of addressing “wicked”, multifaceted health and societal challenges. This is because networks attempt to address these challenges via collaborative approaches in which diverse stakeholders together define the problem(s) and implement solutions. Consequently, there has been a sharp increase in the number and types of networks used in health care. Despite this growth, our understanding of how these networks are governed has not kept pace. The purpose of this chapter is to chart a research agenda for scholars who are interested in studying health care network governance (i.e., the systems of rules and decision-making within networks), which is of particular importance in deliberate networks between organizations. We do so based on our knowledge of the literature and interviews with subject matter experts, both of which are used to identify core network governance concepts that represent gaps in our current knowledge. Our analysis identified various conceptualizations of networks and of their governance, as well as four primary knowledge gaps: “bread and butter” studies of network governance in health care, the role of single organizations in managing health care networks, governance through the life-cycle stages of health care networks, and governing across the multiple levels of health care networks. We first seek to provide some conceptual clarity around networks and network governance. Subsequently, we describe some of the challenges that researchers may confront while addressing the associated knowledge gaps and potential ways to overcome these challenges.

Longitudinally (2008–2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary care and specialty physician practices, and the extent to which variation in PCMH capacity can be accounted for by sociodemographic characteristics of the community.

Linear growth curve models among 523 small and medium-sized physician practices that were members of a consortium of physician organizations pursuing the PCMH.

Our analysis indicated that the average level of sociodemographic characteristics was typically not associated with the level of PCMH capacity, but the heterogeneity of the surrounding community is generally associated with lower levels of capacity. Furthermore, these relationships differed for interpersonal and technical dimensions of the PCMH.

Our findings suggest that PCMH capabilities may not be evenly distributed across communities and raise questions about whether such distributional differences influence the PCMH’s ability to improve population health, especially the health of vulnerable populations. Such nuances highlight the challenges faced by practitioners and policy makers who advocate the continued expansion of the PCMH as a means of improving the health of local communities.

To date, most studies have focused cross-sectionally on practice characteristics and their association with PCMH adoption. Less understood is how physician practices’ PCMH adoption varies as a function of the sociodemographic characteristics of the community in which the practice is located, despite work that acknowledges the importance of social context in decisions about adoption and implementation that can affect the dissemination of innovations.

High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.

Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.

This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.

Public hospitals have long been major players in the US health care delivery system. However, many public hospitals have privatized during the past few decades. The purpose of this chapter was to investigate the impact of public hospitals' privatization on community orientation (CO). This longitudinal study used a national sample of nonfederal acute-care public hospitals (1997–2010). Negative binomial regression models with hospital-level and year fixed effects were used to estimate the relationships. Our findings suggested that privatization was associated with a 14% increase in the number of CO activities, on average, compared with the number of CO activities prior to privatization. Public hospitals privatizing to for-profit status exhibited a 29% increase in the number of CO activities, relative to an insignificant 9% increase for public hospitals privatizing to not-for-profit status.

Nursing homes experience high nursing staff turnover. Nursing staff in nursing homes is comprised of gray and blue collar workers that include registered nurses (RNs), licensed practical nurses (LPNs), and certified nurse assistants (CNAs). The relationship between human resource management (HRM)practices, organizational culture, and nursing staff turnover is examined in underresourced (high Medicaid) nursing homes. Survey data from 348 nursing home administrators (NHAs) of USA high Medicaid (85% or higher) facilities were merged with secondary data sources for 2017–2018. The dependent variables (nursing staff turnover rates) consisted of the percentages of RNs, LPNs, and CNAs that had voluntarily quit the organization during the past year. The independent variables were: (1) HRM practices (employee-centered and high involvement practices); and (2) organizational culture: clan, market, hierarchical, and non-dominant. Organizational and market variables were controlled for. Data were modeled using Poisson log-linear regression, and propensity score weights were used to adjust for potential survey non-response bias. Results show high involvement HRM practices and having a clan culture are associated with lower RN, LPN, and CNA staffing turnover. Study findings suggest that organizational culture and HRM practices may be instrumental in reducing nursing turnover in underresourced nursing homes.